The Myth of Primary Polydipsia: Why Hypovolemic Dehydration Can Explain the Real Physiological Basis of So-Called "Psychogenic Water Drinking"
‘The diagnosis of compulsive water drinking must be made with care and may represent our ignorance of yet undescribed pathophysiological mechanisms.’ - Prof. Daniel Bichet, University of Montreal, 2017.
Primary Polydipsia is currently considered to involve the over-drinking of fluids in the absence of any physiological need and usually, therefore, as a result of mental illness. This book argues that this current conception is the product of a catastrophic Freudian error. Indeed, the idea of “psychogenic water drinking" was first formulated by psychiatrists who attributed the condition variously to conversion disorders, delusional hypochondriasis, female hysteria, not having enough sex, troubled childhoods and other similar ideas of a Freudian nature. Worse is that this early psychological bias also informed the central physiological assumptions and diagnostic procedures regarding the condition, both of which have remained unchallenged to this day.
In this book, Patrick Ussher exposes the Freudian origins of Primary Polydipsia but also proposes a new, and very real, kind of polydipsia which can replace so-called “psychogenic water drinking” and explain its typical clinical presentation in physiological terms. Termed ‘Hypovolemic Dehydration’, this polydipsia is driven by an endogenously created and maintained state of low blood volume. Indeed, there exists a range of hypovolemic illnesses, in particular Myalgic Encephalomyelitis, Postural Orthostatic Tachycardia Syndrome and Long Covid, in which patients routinely suffer from excessive thirst. In all of these illnesses, a downregulation of blood-retention hormones can lead to an ongoing state of low blood volume, often involving a shortfall of around one litre of blood. As a result, the hypovolemic thirst centre activates but, unlike the osmotic thirst centre, this requires appropriately concentrated fluids in order to be quenched. The patient, unaware of the real reason for their thirst, understandably just drinks pure water and thereby enters a vicious cycle of never-ending thirst and urination. Is it patients with hypovolemic illnesses who have always been historically misdiagnosed as “psychogenic water drinkers”?
The tendency of medicine to suggest that symptoms it does not yet understand are psychosomatic has a long history and one that rarely ages well: Parkinson’s, MS and ME patients, among others, have all had to face this kind of stigma. This book argues that patients with so-called “Primary Polydipsia” fall into the same category. These patients are not mentally ill. Rather, their bodies scream with a thirst that is very real and which carries a serious risk of neurological injury and fatality. This book is therefore a clarion call for doctors and medical researchers to return to the drawing board and to reconsider Primary Polydipsia with fresh eyes so that the very sick can, at last, be treated effectively and compassionately by the doctors to whom they turn for help.
How to Get the Book
As I believe strongly in the ideas in my book and wish them to reach as many people as possible, both medical and non-medical, I am making the book available for free download on this site.
If you wish, you can also purchase a paperback edition of the book as well as a Kindle edition on Amazon.
About the Author
He is the author of Stoicism & Western Buddhism: A Reflection on Two Philosophical Ways of Life. He has also written a pseudonymous political satire.
While a Classics PhD student, he was a founding member of the Modern Stoicism project, an interdisciplinary collaboration between academics and psychotherapists working to create modern applications of the ancient Greco-Roman philosophy of Stoicism. As part of that project, he started and ran the project’s blog from 2012 to 2016 and he also edited two books: Stoicism Today: Selected Writings, Volumes 1 & 2.
In 2018, he worked with Columba Press on a new edition of a book by his late mother, Mary Redmond-Ussher, on coping with breast cancer under the title Following the Pink Ribbon Path. Patrick has a BA and MA in Classics (Ancient Greek & Latin) from the University of Exeter, UK.
His website is: www.patrickussher.com
This is a talk I gave to IMET (The Irish ME Trust) at the end of October 2023 in which described my hypothesis for the cause of excessive thirst in ME/CFS. The focus is mainly on that condition but I do talk about the likely link to Primary Polydipsia towards the end of the talk.